Provider Demographics
NPI:1508058447
Name:HERNANDEZ-FRAU, PEDRO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:HERNANDEZ-FRAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 VILLAGE BLVD
Mailing Address - Street 2:STE 702
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1947
Mailing Address - Country:US
Mailing Address - Phone:561-882-6214
Mailing Address - Fax:561-882-6216
Practice Address - Street 1:901 VILLAGE BLVD
Practice Address - Street 2:STE 702
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1947
Practice Address - Country:US
Practice Address - Phone:561-882-6214
Practice Address - Fax:561-882-6216
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1080692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003639900Medicaid
FL003639900Medicaid